Maternal iron deficiency anemia during pregnancy results from

Iron-Deficiency Anemia During Pregnancy Affects Child’s Brain Development

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Iron-Deficiency Anemia During Pregnancy Affects Child’s Brain Development
Iron-Deficiency Anemia During Pregnancy Affects Child’s Brain Development
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What is the iron deficiency anemia that is common anemia for pregnant mothers?
What causes maternal Anaemia?
Does maternal anemia cause fetal anemia?

Iron-Deficiency Anemia During Pregnancy Affects Child’s Brain Development

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We often talk about the importance of planning for pregnancy. In these discussions, we emphasize the importance of supplementation with folic acid as a means of decreasing risk for birth defects and improving neurodevelopmental outcomes in children. A recent study indicates that adequate levels of iron may also play an important role in fetal brain development and that children born to mothers with anemia during pregnancy may have worse neurodevelopmental outcomes.

Using data from the Stockholm Youth Cohort, Swedish researchers evaluated 532,232 children born between January 1, 1987 and December 31, 2010, with follow-up of the children in health registers through 2016. They looked at the association between anemia in the mother (recorded at ? 30 weeks or > 30 weeks) and risk for autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and intellectual disability (ID) in their children.

ASD, ADHD, and ID were more commonly reported among children born to mothers with anemia within the first 30 weeks of pregnancy compared with mothers diagnosed with anemia later in pregnancy (4.9% vs. 3.8% for ASD, 9.3% vs. 7.2% for ADHD, 3.1% vs.1.1% for ID). The results were similar when women with anemia were compared to mothers without anemia (4.9% vs. 3.5% for ASD, 9.3% vs. 7.1% for ADHD, 3.1% vs.1.3% for ID).

After controlling for potential confounders, researchers observed that anemia diagnosed during the first 30 weeks of pregnancy but not later was associated with increased risk of diagnosis of ASD (odds ratio [OR], 1.44; 95% CI, 1.13-1.84), ADHD (OR, 1.37; 95% CI, 1.14-1.64), and ID (OR, 2.20; 95% CI, 1.61-3.01). While the risk of these disorders is elevated, it is important to note that the absolute increase in risk is relatively small.

Although maternal anemia may be associated with other factors associated with worse neurodevelopmental outcomes (i.e., malnutrition, inadequate prenatal care, poor adherence to prenatal vitamins), the researchers attempted to control for these factors. They hypothesize that iron deficiency anemia disrupts fetal brain development, noting that iron is essential for processes including myelination, dendrite arborization, and synthesis of monoamine neurotransmitters.

Given the prevalence of anemia in women of childbearing age, this study underscores the importance of consistent prenatal care and the usage of prenatal vitamins containing iron. It should be noted that not all prenatal vitamins contain the US recommended daily allowance (RDA) of iron (27 mg/day). Some women, including African-American women, vegetarians, and those with intestinal disorders and other chronic illnesses, are at higher risk for iron-deficiency anemia and should talk to their physician about iron supplementation during pregnancy,

Ruta Nonacs, MD PhD

Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders.

Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. JAMA Psychiatry. 2019 Sep 18:1-12.

Does maternal anemia affect fetal neurodevelopment? (Contemporary OB/GYN)

Anemia in Early Pregnancy Linked to Autism, ADHD, Intellectual Disability in Kids (Medscape – free subscription)

Could Mom’s Anemia Hurt Baby’s Brain? (Medpage Today)

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Hemoglobin concentration is used to determine the diagnosis and severity of anemia in low resource settings, an indicator that is routinely screened using WHO-defined hemoglobin cutoffs. These thresholds are lower for pregnant women (females ≥ 15 years of age) than non-pregnant women (11.0 g/dl versus 12.0 g/dl). Severity of anemia is determined using additional cutoffs, with severe anemia defined as a hemoglobin level of less than 7.0 g/dl.

Iron deficiency is defined as a condition in which there are no mobilizable iron stores, resulting from a long-term negative iron balance and leading to a compromised supply of iron to the tissues. Finally, the most significant negative consequence of ID is anemia, usually microcytic hypochromic in nature.

IDA has been linked to unfavorable outcomes of pregnancy. It is the most common nutritional disorder in the world affecting two billion people worldwide with pregnant women particularly at risk. According to WHO report, 2001 indicates that IDA is a significant problem throughout the world ranging from 35-75% in developing countries (average 56%) whereas in industrialized countries the average prevalence is 14%.

Distribution of blood flow (between the placental and cerebral regions) is determined with Middle cerebral artery PI/Umbilical artery PI (C/U ratio); this parameter is always > 1.1 during normal pregnancy, but decreases in the case of hypoxia because of umbilical artery resistance index increase (increase in placental resistance) and cerebral resistance index decrease (cerebral vasodilation).

Perinatal morbidity & mortality of IUGR infants is 3-20 times greater than normal infants. These cases may be followed with outpatient monitoring and they often deliver at term. However process is not severe enough to stop fetal growth completely or to deteriorate. The umbilical artery and the middle cerebral artery waveforms may be abnormal, without effect is seen on Doppler and growth until 26-32 weeks gestation; Mild utero-placental insufficiency.

Iron deficiency and iron deficiency anemia during pregnancy are risk factors for preterm delivery, prematurity and small for gestational age birth weight. Iron deficiency has a negative effect on intelligence and behavioral development in the infant. It is essential to prevent iron deficiency in the fetus by preventing iron deficiency in the pregnant woman.

Prevention and control is typically achieved through iron fortification of food staples like flour and rice and/or through administration of iron supplements most often in iron tablets. Although iron supplements are widely available and fortified foods constitute a major component of the diet in the developed world, access is limited in the developing world

What is the iron deficiency anemia that is common anemia for pregnant mothers?

Folate-deficiency anemia. During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body. Man made supplements of folate are called folic acid.

What causes maternal Anaemia?

The causes of maternal anemia are complex, including infections (malaria and helminth infestations), nutrient deficiencies (iron, folic acid, and vitamin B12), and genetic factors (hemoglobinopathies).

Does maternal anemia cause fetal anemia?

If left untreated, anemia can lead to fetal death. The most common cause for fetal anemia is an incompatibility between the blood type of the mother and the fetus, called isoimmunization. Under these circumstances, antibodies from the mother destroy the red blood cells of the fetus.